CONTRIBUTED

If you have sleep apnea and frequently stop breathing for short periods during the night, you are at higher risk for stroke and early death.

That is the main finding of a study of more than 1,000 patients at the Yale Center for Sleep Medicine that was published last month in the New England Journal of Medicine.

However, most of what the study found isn’t really new, according to Dr. Marc Frost of Pinehurst Neurology, who is board certified in both neurology and sleep medicine. According to Frost, the study primarily reconfirms what physicians have known for years, that people with sleep apnea are more likely to have high blood pressure and suffer strokes and heart attacks.

That being the case, it stands to reason that sleep apnea would be associated with higher death rates. The new finding to come out of the Yale study is that people with sleep apnea have a higher risk of dying regardless of whether they have other risk factors such as high blood pressure or heart disease.

“We used to think there wasn’t necessarily a direct connection between sleep apnea and stroke, because a lot of people with sleep apnea tend to be overweight and have other medical problems,” Frost says. “But there have been studies that eliminated those other risk factors, and it turns out that sleep apnea itself is an independent risk factor. If you have sleep apnea and no other medical problems, you are at an increased risk for stroke and heart attack.”

It isn’t exactly clear what the connection is, but Frost says it is thought to be related to changes in blood pressure and blood vessel tone that occur as a result of sleep apnea.

There are three types of sleep apnea. The most common is obstructive sleep apnea, which occurs when the throat muscles and tongue relax and block the airway. Far less common is central sleep apnea, in which the throat stays open but the body periodically stops breathing.

The third type is a combination of obstructive and central sleep apnea.

During episodes of obstructive sleep apnea, a person keeps trying to breathe, but air can’t get through to the lungs. After a few seconds, the brain detects a lack of oxygen in the blood and signals the muscles in the throat to open the airway. Breathing often resumes with a gasp.

“Every time you stop breathing, you have to wake up to start again and then go back to sleep,” Frost says. “You may not know you keep waking up, because you are only awake for a few seconds, but the brain does wake up.”

That explains why people with sleep apnea are more likely to feel tired and sleepy during the day. They also tend to be less productive.

Sleep apnea is associated with higher rates of diabetes, depression, sexual dysfunction, learning difficulties and traffic accidents.

Nearly everyone with obstructive sleep apnea snores, but not everyone who snores has sleep apnea. Obstructive sleep apnea is most common in men and post-menopausal women, in people who are overweight and in people who still have their tonsils. Estimates of the prevalence of obstructive sleep apnea range from 10 percent to 40 percent of people who are middle-aged and older.

“If we suspect that someone has sleep apnea, we can test them for it by having them spend a night in a sleep lab,” Frost says.

All three FirstHealth hospitals — Moore Regional Hospital in Pinehurst, Richmond Memorial Hospital in Rockingham and Montgomery Memorial in Troy — have sleep disorders centers. Throughout the night, while the patient is sleeping, the lab equipment monitors brain wave activity, respiratory effort, airflow, heartbeat, eye movement and muscle activity. The sleep study shows how often the patient stops breathing and for how long, as well as when the brain is asleep and awake.

For people whose sleep apnea is relatively mild and occurs mostly when they are sleeping on their back, Frost often recommends simple, low-tech solutions.

“They can get a T-shirt with a pocket on it, put a tennis ball in the pocket and then wear the shirt backward, and this will keep them from sleeping on their back,” he says.

If sleep apnea is more serious and doesn’t occur only when the individual is sleeping on his or her back, the most effective way to treat it is usually with a machine that blows a steady stream of air into the nose or mouth. This treatment is called CPAP, which stands for continuous positive airway pressure.

“I typically start patients off with the CPAP, because it usually works,” Frost says. “It’s just a matter of fitting them with a mask they can wear comfortably while they sleep.”

Some people do well with dental appliances that keep the airway open by pulling the tongue and jaw forward. Surgery is often effective if sleep apnea is caused by an anatomical obstruction such as unusually large tonsils. Occasionally, more extensive and complex surgery is needed.

Overall, surgery for sleep apnea has a cure rate of about 50 percent.

According to Frost, people who think they might have sleep apnea should talk with their physician.

“If you’re not sleeping well, or you often feel tired during the day, or your spouse says you snore all the time, there could be any number of reasons, but you ought to have it looked into,” he says. “There are serious health risks with sleep apnea if it isn’t treated.”